Breastfeeding

WHO rules call for support for breastfeeding (The Hindu: 20180413)

http://www.thehindu.com/sci-tech/health/who-rules-call-for-support-for-

breastfeeding/article23516333.ece

Health facilities requested to follow 10 important steps

The World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF)

on Thursday issued a new 10-step guidance to increase support for breastfeeding in health

facilities that provide maternity and newborn services, which provide the immediate health

system platform to help mothers initiate breastfeeding within the first hour and breastfeed

exclusively for six months.

Breastfeeding all babies for the first 2 years would save the lives of more than 8,20,000

children under age 5 annually, noted a release issued by the WHO.

The guidelines describe how hospitals should have a written breastfeeding policy in place,

required staff competencies, and antenatal and post-birth care, including breastfeeding

support for mothers.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayFriday 20180413

It also recommends limited use of breast milk substitutes, rooming-in, responsive feeding,

educating parents on the use of bottles and pacifiers, and support when mothers and babies

are discharged from hospital.

“Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last

well into adulthood.

“But breastfeeding requires support, encouragement and guidance. With these basic steps,

implemented properly, we can significantly improve breastfeeding rates around the world and

give children the best possible start in life,” said UNICEF Executive Director Henrietta H.

Fore.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus said that in many hospitals and

communities around the world, whether a child can be breastfed or not can make the

difference between life and death, and whether over a child will develop to reach his or her

full potential.

Ayushman Bharat

Can Ayushman Bharat make for a healthier India? (The Hindu: 20180413)

http://www.thehindu.com/opinion/op-ed/can-ayushman-bharat-make-for-a-healthier-

india/article23516837.ece

Building a robust primary health-care system will save lives and lead to a healthier India

Ayushman Bharat, the new, flagship health initiative of the government, has two dimensions.

First, it aims to roll out comprehensive primary health care with Health and Wellness Centres

(HWCs) serving as the people-centric nuclei. A nationwide network of 1.5 lakh HWCs will

be created by transforming the existing sub-centres and primary health-care centres by 2022.

This will constitute the very foundation of New India’s health care system.

So far, the country’s primary health care has been focussing on reproductive, maternal health,

newborn and child health as well as controlling priority communicable diseases. All this

perhaps covers only 15% of our needs. Public health action for preventive/promotive health

has also been limited. There is a huge unmet need for primary health care, namely, care for

non-communicable diseases (specifically, prevention and early detection and treatment of

hypertension, diabetes, chronic obstructive lung disease, and common cancers), mental

health, care of the aged, adolescent health, palliative health care, basic eye care and dental

health.

If we build a strong, robust next generation primary health-care system, it will save lives and

will lead to a healthier India. For instance, detecting and treating diabetes from the age of 35

years by a screening test would avert kidney failure at 50 years in case the condition remains

undetected and untreated.

The government has committed for two-thirds of resources to go into a comprehensive

primary health care as part of the National Health Policy 2017. The HWCs are somewhat on

the lines of the U.K. general practices health system, but run largely by nurse practitioners

and trained health workers, which are accessible near home.

Prevention and positive behaviours are the key to good health, productivity and a long life.

Healthy families, villages and cities is the goal of the primary health-care system. HWCs will

help unleash a people’s movement for a healthy India.

Providing insurance

The second dimension of Ayushman Bharat is the National Health Protection Scheme which

aims to provide health cover of ₹5 lakh per family per year for hospitalisation in secondary

and tertiary care facilities. In one go, given the ambitious size of the package, 40% of people,

neonates to young and old, will have access to facility care for almost all the medical and

surgical conditions that could occur in a lifetime. The programme will cover half a billion

people and would align with what the State governments are doing already, with significant

resources coming from the Centre. Many State governments would extend the benefits to

additional beneficiaries through their own resources so that ultimately the population covered

for catastrophic expenses could be two-thirds of India’s population, if not more. This mission

enables increased access to in-patient health care for the poor and lower middle class. The

access to health care is cashless and nationally portable. The scheme would enable a weaver

in a remote village to be able to walk into a hospital for a gall bladder stone surgery or a

coronary stent without having to pay the hospital. Treatment will be provided by empanelled

public and private hospitals. Private hospitals will have to agree to terms such as package

rates, adherence to standards and guidelines, ethical practice, respectful care and client

satisfaction, and transparency.

Ayushman Bharat will spur increased investment in health and generate lakhs of jobs,

especially for women, and will be a driver of development and growth. It is a turning point

for the health sector.

Vinod Paul is Niti Aayog member and a professor of paediatrics at the All India Institute of

Medical Sciences.

With no preventive, promotive or outpatient

care, it may not lead to larger public benefits

No. In brief, because its centrepiece, the National Health Protection Scheme (NHPS), also

called ‘Modicare’, is just an existing scheme re-announced with some expansion; the funds

allocated are grossly inadequate; this scheme would overlap with many established State

health insurance schemes; and most importantly, the scheme does not deal with preventive,

promotive or outpatient care, so it is unlikely to lead to larger public health benefits.

Old wine in a new bottle

The NHPS is not a new scheme, in fact it was announced in the 2016 Budget — the only

difference being that the sum assured until now was ₹1 lakh, which has been raised to ₹5

lakh. In the last two years, the NHPS has been a non-starter — the reason for its failure is that

many large States already have established health insurance schemes, and for most

requirements their existing allocations of ₹1.5-2 lakh were quite adequate. So, this ‘old wine

in new bottle’ scheme offers hardly any advantage.

The allocation of ₹2,000 crore to cover 50 crore households, amounting to barely ₹40 per

person per year, is barely enough to cover one strip of tablets annually. Even the later

projected amount of ₹11,000 crore is less than half of the minimum amount required for this

scheme.

This scheme seeks to build on existing Rashtriya Swasthya Bima Yojana (RSBY), but does

not address many problems associated with RSBY. Reviews show that RSBY has not

reduced health-care costs for the poor, with many States discontinuing it. There is no

evidence that the NHPS will correct the distortions associated with RSBY, so results may be

similar.

The NHPS is not a move towards Universal Health Care since even in the best case scenario,

80 crore (60% of the population) would be left out; outpatient care (responsible for 70% of

people’s expenditure) is not covered; and being focussed on hospitalisation, there is no

evidence that it would be integrated with primary level health care.

The Finance Minister made a hilarious statement that the NHPS is the ‘world’s largest

government-funded health care programme’, shocking since the scheme is allocated just

₹2,000 crore, while the government’s own National Health Mission with annual outlay of

₹30,000 crore is ignored. India’s public health services are allocated close to ₹100,000 crore

annually.

However, such equating of health care with insurance schemes is extremely problematic. The

U.S. is the only developed country without a Universal Health Care (UHC) system; based on

commercial health insurance, its system is very expensive and excludes a huge number of

people. Introducing the American model based on commercial insurance is unsustainable for

India, and may lead to unnecessary procedures without improvement in health outcomes.

There are strong reasons to believe that the main intention of the NHPS, launched by a

‘business friendly’ government, may be to include and support corporate health-care

providers, while boosting health insurance companies.

The other component of Ayushman Bharat is 1.5 lakh Health and Wellness Centres projected

to provide comprehensive health care. With ₹1,200 crore supposed to be committed in the

Budget for this, this would support only about 10,000 HWCs — less than 7% of what has

been projected. More seriously, scrutiny of the current year’s health Budget shows no

dedicated allocation for HWCs, rather this will have to be carved out of the existing NHM

budget, which has itself seen a 5% cut compared to revised Budget estimates of last year.

Given all this, ‘Ayushman Bharat’ with its promise to cover ₹5 lakh for every family, should

not become another ‘jumla’.

Abhay Shukla is the national convenor of Jan Swasthya Abhiyan.

IT'S COMPLICATED | T. SUNDARARAMAN

Can Ayushman Bharat make for a healthier India?

Public provisioning of primary care has been central to realising the right to health care

The scheme has two parts — the National Health Protection Scheme (NHPS) and the Health

and Wellness Centres (HWCs). The former has received wide media coverage, the latter

remains largely unknown. The Budget speech called HWCs the foundation of India’s health

system. Both in the developed world and in the developing world, public provisioning of

primary health care has been the central strategy of realising the right to health care.

Currently, the health sub-centres and primary health centres in India are limited to only some

elements of maternal and child care and control of two or three major infectious diseases.

What HWCs would do is to upgrade and increase the capacity of these centres to provide care

for a large range of chronic illness and infectious disease.

But there are three essential pre-requisites. The first is an additional budgetary allocation of

about ₹20 lakh per HWC per year, which would work out to about ₹30,000 crore per year.

This would be great value for money. But there are no indications of such a commitment —

either in this year’s Budget nor the budget allocation that went along with the extension of the

NHM. The second condition is a matching human resource policy — which includes in the

least a regular salaried workforce of at least three auxiliary health workers per HWC. Also,

reforms in the way that these 3 lakh health additional workers would be recruited, trained and

retained, so that they are available where they are needed most. But on the ground,

governments, driven by both ideological and financial barriers, have been reducing

recruitment and contractualising the work force. Third, this needs a well-coordinated referral

mechanism with specialists and doctors in the secondary and tertiary hospitals, but there is

very limited effort, investment and even thought going into this.

Insurance gaps

If the silence shrouding HWCs is the problem, with respect to the NHPS it is the noise. It is a

publicly-funded health insurance programme, with a limited budget, designed to provide

financial protection for the poor against costs of secondary and tertiary health care. Many

States already have similar programmes in place. First, insurance does little for access to

hospital care in vast areas where there are no providers. That needs public investment.

Second, in the absence of any effective regulation of the private sector, and given high levels

of information asymmetry, the consumption of services is determined more by what private

providers find more profitable to provide, rather than health-care needs of the poor.

Even its outcomes in terms of financial protection are uncertain. By design, such schemes

exclude outpatient care which caters to the majority of health-care needs and accounts for

most of the expense and impoverishment due to health-care costs. And it should stay

excluded. The NHPS could play a useful role, as an alternative and more flexible financing

route for tertiary care in both public hospitals and for purchasing care from a more public

service and less commercially oriented segment of the private sector where there are critical

gaps. It could have been designed to supplement rather than substitute the public hospital.

And some States have shown this is possible.

Where States have already established insurance programmes, the NHPS could finance these,

instead of replacing them. And where they do not have a programme, learning from

experience, if the sum assured was kept at ₹2 lakh or less, the NHPS would have a modest

but important contribution to make.

But then these are times when any pro-poor public expenditure is dismissed as fiscal

indiscipline, unless it can be routed in a manner where corporate private sector can profit

from it.

T. Sundararaman is a professor at TISS and former executive director of National Health

Systems Resource Centre.

Public health

Night owls are at a higher risk of dying young than early birds (The Times

of India: 20180413)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/

Paris: People who stay up late and have to drag themselves out of bed in the morning are

likelier to die younger than those who rise and set with the sun, researchers said on Thursday.

A survey of more than 4,30,000 people in Britain found that those who were night owls had a

10% higher risk of dying than “larks”.

“This is a public health issue that can no longer be ignored,” said study co-author Malcolm

van Schantz of the University of Surrey, adding that “night types” should be allowed to start

and finish work later in the day.

“Night owls trying to live in a morning-lark world may (suffer) health consequences,” said

fellow author Kristen Knutson of the Northwestern University in Chicago.Researchers

gathered information on nearly half-a-million people aged 38-73 from a public database.

Deaths in the group studied — just over 10,500 in total — were documented for six-and-ahalf

years.

The night owl group, the team found, had a 10% higher risk of dying than those in the

extreme early-morning group.

People in the late-night group were more likely to suffer from psychological disorders,

diabetes, and stomach and breathing troubles, and slept fewer hours per night.

The higher risk may be because “people who are up late have an internal biological clock that

doesn’t match their external environment,” Knutson said. AFP

E-cigarettes

Govt to ban e-cigarettes, Health Ministry tells Delhi HC (The Indian

express: 20180413)

http://indianexpress.com/article/cities/delhi/govt-to-ban-e-cigarettes-health-ministry-tells-

delhi-hc-5135393/

The ministry said “nicotine addiction through e-cigarettes among young people may lead to

its consumer to try conventional tobacco products and hence is a gateway product”.

THE MINISTRY of Health and Family Welfare has informed the Delhi High Court that it is

in the process of formally banning e-cigarettes in larger public interest as its chief constituent

nicotine is addictive and can lead to diseases, besides risk of miscarriage in pregnant women.

The ministry told this to a bench of Acting Chief Justice Gita Mittal and Justice C Hari

Shankar, who were hearing a plea seeking to regulate the sale and consumption of e-

cigarettes.

The ministry said “nicotine addiction through e-cigarettes among young people may lead to

its consumer to try conventional tobacco products and hence is a gateway product”.

The ministry was responding to a plea by Seema Sehgal, a homemaker, who sought

directions to the governments to formulate guidelines for sale, production and supply of the

product.

Delhi government’s additional standing counsel Sanjoy Ghose told the court that they were

also planning to ban it.

Pollution sources

Safar begins drive to list, study pollution sources (Hindustan Times:

20180413)

http://paper.hindustantimes.com/epaper/viewer.aspx

From page 02 how much they travel everyday and the amount of fuel they use,” he added.

The scientists hope to gather data from at least 30%-40% roads in Delhi and cover around

500 intersections.

HT FILE

n Delhi’s air quality usually shows a sharp decline in the second half of the year despite

stringent measures being put in place.

The teams will be visiting some of the biggest slums in the national capital, around 80 major

construction sites, road side eateries and dhabas to gather data of various kinds including the

type of fuel that is used.

“Once we get all the data these would be fed to a GIS-based statistical model developed by

the Indian Institute of Tropical Meteorology in Pune for better and more accurate forecasts,”

Beig said.

Scientists said that unlike the previous study which had a resolution of around 1.67sqkm, this

time the resolution would be 400 sqm, which would give the authorities a better idea of the

pollution sources in each and every part of Delhi.

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Iron supplements

Certain iron supplements linked to colon cancer (New Kerala: 20180413)

https://www.newkerala.com/news/fullnews-352499.html

Certain iron supplements may influence the development of colon cancer, a new research has

found.

According to Chalmers University of Technology-led study, two compounds, ferric citrate

and ferric EDTA, are often used in dietary supplements and as a food additive respectively, in

worldwide markets including the USA and the EU, increase the formation of a known

biomarker for cancer.

The new study looked at the effect of normal supplemental doses of these compounds on two

types of cultured human colon cancer cells. As a comparison, they also measured the effects

of ferrous sulphate, another very commonly available iron compound.

While ferrous sulphate had no effect, both ferric citrate and ferric EDTA caused an increase

in cellular levels of amphiregulin, a biomarker for cancer. This was the case even at low

doses.

"We can conclude that ferric citrate and ferric EDTA might be carcinogenic, as they both

increase the formation of amphiregulin, a known cancer marker most often associated with

long-term cancer with poor prognosis," said lead author Nathalie Scheers.

"Many stores and suppliers don't actually state what kind of iron compound is present - even

in pharmacies. Usually, it just says 'iron' or 'iron mineral', which is problematic for

consumers," she added.

Most of the iron that the body needs is obtained through food such as meat, fish, vegetables,

fruits and whole grains. But sometimes this is not enough. Pregnant women may need

additional iron, as well as people who have lost blood or have low hemoglobin levels for

other reasons. In patients with kidney disease, high doses of iron may be needed to bind

phosphates into the bloodstream.

The findings from the study are published in the journal Oncotarget.

Malaria

Novel bed net provides greater protection against malaria (New Kerala:

20180413)

https://www.newkerala.com/news/fullnews-352333.html

: A new kind of bed net can emerge as a potent weapon against malaria as a two-year trial

involving more than 15,000 children has shown that it can significantly increase protection

against the mosquito-borne disease.

The trial in Tanzania showed that a long lasting insecticidal net treated with a chemical called

piperonyl butoxide (PBO LLIN) reduced the prevalence of malaria by 44 per cent and 33 per

cent in the first and second year respectively, compared to a standard net treated with

pyrethroid only.

The study, published in the journal Lancet, also showed drastic malaria control through

indoor residual spraying (IRS) with the insecticide pirimiphos methyl, which after a single

spray round reduced malaria infection by 48 per cent for an entire year.

"The trial is the first clear evidence that nets treated with piperonyl butoxide can significantly

improve personal and community protection from malaria compared to standard pyrethroid-

only nets in areas where there is high pyrethroid resistance," said principal investigator Mark

Rowland from London School of Hygiene and Tropical Medicine.

"It also demonstrated that pyrethroid resistance is now a significant problem in some areas

and standard LLIN are less effective than before, and that the new IRS controlled malaria for

an entire year before needing to be re-sprayed," Rowland said.

Anticipating the possible failure of current control tools due to resistance, the World Health

Organization (WHO) and the London School of Hygiene and Tropical Medicine have been

collaborating with the chemical industry for almost 20 years to develop new types of LLIN

and new insecticides for IRS.

One of these is a novel LLIN which incorporates piperonyl butoxide (PBO), a chemical

which blocks the natural defence mechanisms of insects - the oxidase enzymes that would

otherwise metabolise insecticide - which means the pyrethroid on the LLIN remains potent

against mosquitoes despite resistance.

This chemical synergist stops insects from breaking down the pyrethroid within their bodies,

so the insecticide stays toxic to the insect.

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